Celiac Disease - Sprue

Celiac disease is a condition caused by damage to the lining of the small intestine.
This damage comes from a reaction to eating gluten. This is a substance that is found
in wheat, rye, barley, and possibly oats. It is also found in food made from these
ingredients.

The damaged intestine does not absorb needed components of food.

Alternative Names

Causes

The exact cause of celiac disease is unknown. The lining of the intestines have small
areas called villi which project outward into the opening of the intestine. These
structures help absorb nutrients.

When people with celiac disease eat foods with gluten, their immune system reacts
by damaging the villi.

Because of the damage, the villi are unable to properly absorb iron, vitamins, and
other nutrients.

As a result, a number of symptoms and health problems may occur.

The disease can develop at any point in life, from infancy to late adulthood.

People who have a family member with celiac disease are at greater risk of developing
the disease. The disorder is most common in Caucasians and persons of European ancestry.
Women are affected more often than men.

Symptoms

The symptoms of celiac disease can be different from person to person. This can make
diagnosis difficult. For example, one person may have constipation, a second may have
diarrhea, and a third may have no problem with stools.

Blood tests can detect antibodies, called antitissue transglutaminase antibodies (tTGA)
or anti-endomysial antibodies (EMA) which may help detect the condition. The health
care provider will order these antibody tests if celiac disease is suspected.

If the tests are positive, upper endoscopy is often performed to sample a piece of tissue (biopsy) from the first part of the
small intestine (duodenum). The biopsy may show a flattening of the villi in the parts
of the intestine below the duodenum.

Genetic testing of the blood can also be done to help determine who may be at risk
for celiac disease.

A follow-up biopsy or blood test may be ordered several months after the diagnosis
and treatment. These tests assess how well treatment is working. Normal results mean
that you have responded to treatment. This confirms the diagnosis. However, this does
not mean that the disease has been cured.

Treatment

Celiac disease cannot be cured. Your symptoms will go away and the villi in the lining
of the intestines will heal if you follow a lifelong gluten-free diet. Do not eat foods, drink beverages, or take medicines that contain wheat, barley,
rye, and possibly oats.

You must read food and drug labels carefully to look ingredients that may include
these grains. It may be hard to stick to a gluten-free diet because wheat and barley
grains are common in the American diet. Over time, most people are able to adapt and
get better. You should NOT begin the gluten-free diet before you are diagnosed. Starting
the diet will affect testing for the disease.

In most cases, following a well-balanced, gluten-free diet is the only treatment you
need to stay well. Your health care provider may need to prescribe vitamin and mineral
supplements.

Sometimes, short-term use of corticosteroids (such as prednisone) may be needed if
sprue does not respond to treatment.

When you are diagnosed, get help from a registered dietitian who specializes in celiac
disease and the gluten-free diet. A support group may also help you cope with the disease and diet.

Outlook (Prognosis)

Following a gluten-free diet heals the damage to the intestines and prevents further
damage. This healing most often occurs within 3 to 6 months in children. Recovery
may take 2 to 3 years in adults.

Rarely, long-term damage will be done to the lining of the intestines before the diagnosis
is made.

Some problems caused by celiac disease may not improve, such as a shorter than expected
height and damage to the teeth.

Possible Complications

You must carefully continue to follow the gluten-free diet. When untreated, the disease
can cause life-threatening complications.

Delaying diagnosis or not following the diet puts you at risk for related conditions
such as:

When to Contact a Medical Professional

Call your provider if you have symptoms of celiac disease.

Prevention

Because the exact cause is unknown, there is no known way to prevent the development
of celiac disease. However, being aware of the risk factors (such as having a family
member with the disorder) may increase your chances of early diagnosis, treatment,
and a long, healthy life.